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Foto på Mattias Ohlsson

Mattias Ohlsson

Professor

Foto på Mattias Ohlsson

Human Leukocyte Antigen-Based Risk Stratification in Heart Transplant Recipients-Implications for Targeted Surveillance

Författare

  • Johan Nilsson
  • David Ansari
  • Mattias Ohlsson
  • Peter Höglund
  • Ann Sofie Liedberg
  • J. Gustav Smith
  • Pierre Nugues
  • Bodil Andersson

Summary, in English

Background Human leukocyte antigen (HLA) matching isn't routinely performed in heart transplantation. Novel allograft perfusion methods may make HLA matching feasible. The purpose of this study is to reexamine whether HLA mismatch may be used in risk stratification to improve outcomes in heart transplantation. Methods and Results We analyzed 34 681 recipients undergoing heart transplantation between 1987 and 2013. We used HLAMatchmaker to quantify HLA eplet mismatches and Cox regression for analysis of time to graft loss. Recipients with 4 mismatched HLA-DR/DQ alleles and >40 eplets reached an adjusted hazard ratio (HR) for graft loss of 1.17 (95% CI 1.07-1.28) and 1.11 (95% CI 1.03-1.21), respectively. We found significant interaction between recipient age and numbers of HLA-DR/DQ allele and eplet mismatches resulting in an adjusted HR of 1.78 (95% 1.13-2.80) and 1.82 (95% CI, 1.23-2.70), respectively. HR for both interaction terms was 0.99 (95% CI, 0.98-1.00). Risk of graft loss was more pronounced after 1 year, where recipient <40 years with 4 mismatched HLA-DR/DQ alleles and >40 eplets had an adjusted HR of 1.51 (95% CI 1.12-2.03) and 1.32 (95% CI 1.02-1.70), respectively. Pre-sensitized recipients with panel reactive antibodies >10% had an adjusted HR=1.27 (95% CI 1.16-1.40) for graft loss within 1 year but not thereafter. HLA eplet mismatch was independent of panel reactive antibodies on reduction of graft loss within and after 1 year, P (interaction)=0.888 and 0.389. Conclusions HLA mismatch may be used in risk stratification for intensified post-transplant surveillance and therapy.

Avdelning/ar

  • Robotik och Semantiska System
  • Thoraxkirurgi
  • Artificiell intelligens och bioinformatik inom thoraxkirurgisk vetenskap
  • eSSENCE: The e-Science Collaboration
  • Hjärt- och lungtransplantation
  • Artificiell intelligens och thoraxkirurgisk vetenskap (AICTS)
  • Computational Biology and Biological Physics - Has been reorganised
  • Avdelningen för klinisk kemi och farmakologi
  • Avdelningen för mikrobiologi, immunologi och glykobiologi - MIG
  • Heart Failure and Mechanical Support
  • Kardiologi
  • EpiHealth: Epidemiology for Health
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • Institutionen för datavetenskap
  • ELLIIT: the Linköping-Lund initiative on IT and mobile communication
  • Kirurgi, Lund

Publiceringsår

2019-08-06

Språk

Engelska

Publikation/Tidskrift/Serie

Journal of the American Heart Association

Volym

8

Issue

15

Dokumenttyp

Artikel i tidskrift

Förlag

Wiley-Blackwell

Ämne

  • Cardiology and Cardiovascular Disease

Nyckelord

  • HLAMatchmaker
  • human leukocyte antigen
  • rejection
  • risk stratification
  • survival
  • transplantation

Aktiv

Published

Forskningsgrupp

  • Artificial Intelligence and Bioinformatics in Cardiothoracic Sciences (AIBCTS)
  • Heart and Lung transplantation
  • Artificial Intelligence in CardioThoracic Sciences (AICTS)
  • Heart Failure and Mechanical Support

ISBN/ISSN/Övrigt

  • ISSN: 2047-9980